The Burden Of Cardiovascular Disease - What Employers Need To Know And Do
Every thriving business has, at its heart, a core group of people who believe passionately in its mission and have the skills necessary to manage it successfully. Their understandable focus on the mission can, however, distract from gathering threats to their competitive survival. All American businesses face the approaching tidal wave of chronic disease as a consequence of the obesity crisis, specifically, cardiovascular disease and diabetes. The obesity crisis may not be a problem of the business community's making but, like many other societal upheavals, it is one that business stakeholders must grapple with, for ignoring it is a perilous path.
Not to put too fine a point on it but we are the heaviest multicultural society in human history. The nearly unabated march of obesity through America is fundamentally driving both rising medical care costs and the dilemma about how to address them. In 1990, in only ten states were 10 percent or more of adults obese and in no state did the obese population exceed 15 percent of adults. By 2007, 49 states had an obesity rate exceeding 20 percent of adults (Colorado was the only exception); in 30 states, the adult obesity rate exceeded 25 percent; and in Alabama, Tennessee, and Mississippi it exceeded 35 percent of adults.
For the first time, not only are two-thirds of American adults overweight or obese but the obese now outrank those who are merely overweight, with 33 percent of men and 35 percent of women having reached this critical benchmark .
The implications of the cardiovascular disease crisis are startling:
- Nearly 20 percent of all spending by private health plans (which includes self-insured employers) is attributable to obesity.
- Cardiovascular disease consumes a disproportionate share of medical care dollars ($313 billion annually in direct medical care costs) and is the single largest source of lost productivity ($161 billion annually).
- Kaiser Permanente of Northern California has reported that 17 percent of spending for its non-Medicare population was on cardiovascular disease and that most of this paid for inpatient hospital care.
- The costs of revascularization (such as coronary artery bypass surgery or CABG) are substantial. The mean cost of CABG (multi-vessel) is approximately $31,000 in year one, $55,000 by year four, and, over $150,000 lifetime.
- Diabetes, a powerful risk factor for heart disease, is reaching epidemic proportions in our culture. It now accounts for $116 billion in medical care spending annually, with over 50 percent of this total going to pay for inpatient hospital care. Approximately eight percent of the U.S. population has type II diabetes (24 million people), with about of those unaware of their ailment. The proportion of Americans with diabetes is expected to exceed 10 percent of the population by 2011.
- The lifetime risk of diabetes for a person born in 2000 is now nearly 35 percent, due in large part to the overweight/obesity crisis. Businesses will pay these costs, because many of these children are covered dependents. Overweight/obese parents are highly likely to produce overweight/obese children, predominantly because of health behaviors and lifestyle habits that get passed from one generation to the next.
- On average, a person with type II diabetes has nearly double the claims incurred experience ($11,744 each year), compared to a person who does not have the disease ($6,649). In addition, the claims excess varies by age, with adults over age 54 experiencing more than $9,000 per year in excess claims.
- Diabetes ages people prematurely, dramatically cutting productivity and lifespan. Diabetics in their 40s with increased risk of heart disease may lose as much as 15 years off their lives. This implies an increased risk of death when work experience, knowledge, leadership ability and earning power are in their peak years.
Business owners, directors and senior managers now find themselves at a critical juncture. Complacency and the misplaced longing for health reform from Washington, DC could lull many to sleep, with the false impression that the health care system - either extant or reformed - can actually fix this problem. It cannot.We have crossed the medical care cost Rubicon and it is now up to each individual enterprise to exercise its own form of risk management and alter the health culture within its walls.
A surfeit of work groups, commissions and blue ribbon panels tells us that we need national plans for obesity, physical activity and condemnation of the food industry; this is make-work for federal bureaucrats and academics. What we really need is a return to responsible decision making on the ground, where change has the potential for making a real difference: in each household and in every workplace. Each business and each employee must craft sustainable, evidence-based lifestyle management strategies that can mitigate the risk of these two fiscally and clinically punishing chronic conditions.
The future is not lost however, as long as corporate leaders, particularly those in mid-sized companies (100 to 1,000 workers) where the wellness movement has yet to take root, embrace the following strategic points.
Acknowledge that this is indeed a problem you must face.
The first step in solving a problem is acknowledging that you have one and corporate leaders who cannot take this step are committing a breach of their fiduciary duty to their firm's shareholders. Complaining about rising medical care expenditures without doing something about them is not a strategy, it is a form of denial.
Gain insight on the health culture in your company.
American adults spend more of their waking hours at work than they do any other activity. This makes the workplace an ideal vehicle for creating opportunities for change. You can maximize the health culture within your firm by doing things ranging from the simple (serving fresh fruit and bottled waters at firm meetings rather than bagels and donuts) to the complex (ensuring flexibility in scheduling to give people the opportunity to exercise before, during or after work hours).
What do your vendors stock in vending machines? What is served in your cafeteria? Do you price food sold on premises differentially - that is, are foods high in fat, sodium or refined carbohydrates more expensive than healthier options? Does your cafeteria super size' portions? Do managers look like they take their own fitness seriously?
Tell your employees that this will require an integrated approach in which management and workers must row in the same direction.
Educate employees about the fact that health benefits (whether fully insured or self-insured) are part of their overall compensation package and that every dollar flowing there is a dollar not available for other purposes, including salaries, bonuses, marketing, training or other uses. Expand their understanding of the "tax" that everyone in the company pays to care for preventable problems when people fail to leverage the only form of prevention proven to both work AND save money: better fitness.
Find out where you spend your health care dollars.
Companies are often surprisingly unaware of how they spend their medical care dollars. To wit, in 2007, I reviewed data from a major defense contractor and discovered that $0.22 of every medical dollar paid for the care of cardiovascular disease. The company's insurance brokers were unaware of this data. The next two biggest chunks of spending went to endocrinology (diabetes management) and depression.
These are all diagnostic categories where a company can get a bigger bang for its buck by helping to teach employees how to help themselves, especially through evidence-based fitness and body weight management strategies.
Get the fad out. Help educate your employees about evidence-based health strategies that work, because health and fitness strategies are not all the same.
The fitness industry is suffused with faddists and charlatans; employees need help to learn how to discern fact from fiction.
Focus on fitness. Almost nothing matters more to better health and vitality than improved physical capacity.
People with the lowest level of fitness have a 70 percent greater risk of death - from any cause - than people with high fitness and a nearly 60 percent greater risk of death from cardiovascular disease. Focus on fitness first and weight loss second. Exercise's impact on metabolic markers and its potential to enhance the success of a broad range of dietary strategies is irreplaceable, and the obverse is not true of weight loss diets. You can lose a lot of weight and still be profoundly unfit.
Build a health perspective into everything your company does.
Include health tips and references in all company-to-employee communications, whether they are pay check envelope stuffers, e- or paper newsletters or posters and murals on walls. Provide a company health update (i.e., the impact of medical care spending on our firm) at every company meeting. Encourage managers to occasionally hold walking meetings with their teams. Engage with your community planners and zoning commission to work towards a local environment that is conducive to walking, if nothing else.Fitness success that diminishes the burdens of cardiovascular disease and diabetes is not about capitalizing a gym or aiming to create teams of Olympic athletes.
The goals are much more pedestrian (pardon the pun). It is about simply aiming to move employees into the normal range for fitness and, if possible, help as many of them as possible shift from obese to overweight. Good health is, first and foremost, a cognitive play. The process of successful change starts with strategic thinking and an analytic approach to your unique business environment and your employees. Changing the trajectory of medical care spending driven by cardiovascular disease and diabetes requires that business leaders demonstrate novel forms of stewardship and risk management in their organizations.
Absent the will to change, employers and their workers can look forward to years of persistently rising medical care costs with largely no one to blame but themselves. We have met the progenitors of the medical care cost crisis, and they are us.
About the Author
Vik Khanna is an America College of Sports Medicine (ACSM) Certified Clinical Exercise Specialist. He is the President and CExO (Chief Exercise Officer) of Galileo Health Partners, LLC of Ellicott City, MD. Vik employs an inimitable brand of evidence-based exercise and nutrition coaching to teach clients that exercise and diet are critical tools for managing health risks, maximizing quality of life, optimizing medical care spending, and improving both physical capacity and cognitive performance. Vik and his coaching team develop and implement wellness coaching programs for employees and management teams at mid-sized businesses in the mid-Atlantic region.
Their work has helped achieve median weight loss of 5.1% over a 12-month period for enrolled employees and helped half their diabetic adults convert to having normal HbA1c levels. Their programs focus on helping employees build consistent physical activity habits and dietary strategies that are science-based. Vik is chief advisor to the Freddie Mac Foundation in its efforts to create health and wellness opportunities for families returning to New Orleans to live in redeveloped affordable housing communities.
His work, a groundbreaking effort improve health behaviors in vulnerable families, evinces a commitment to the principle that personal health management is learned, not intuitive, and that many low-income and working class people get precious little guidance on how to reduce their health risks through judicious physical activity and better diet. The health and wellness program that Vik has created aims to help families build self-efficacy, thus assisting in their economic stabilization and educational advancement. Vik lectures MBA candidates at the Robert H. Smith School of Business, is a graduate advisor to students in the Physician Assistant Program at Drexel University.
Vik is a physician assistant, with a graduate degree in public health from Johns Hopkins University. His unique combination of clinical knowledge and insightful approach to data analysis enables him to strategize solutions for his corporate clients that are evidence-based, scientifically and medically sound, and measurable. Vik has used his broad health care experience to pen two critically acclaimed books, The Ten Commandments of Faith and Fitness, with Pastor Henry Brinton (CSS Publishing Co., 2008) and Managed Care Made Easy (People's Medical Society, 1997).
He has also written nearly four dozen other papers, monographs, and articles. He speaks frequently on health and fitness issues for his corporate clients. Vik is a member of American College of Sports Medicine (ACSM), the Clinical Exercise Physiology Association, and the International Association for Worksite Health Promotion, both affiliates of the ACSM.